Provider Demographics
NPI:1366887440
Name:BRANCH, JASON (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BRANCH
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TAYLORS MILLS RD UNIT 635
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7027
Mailing Address - Country:US
Mailing Address - Phone:732-784-7879
Mailing Address - Fax:
Practice Address - Street 1:81 STOKES ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1640
Practice Address - Country:US
Practice Address - Phone:732-784-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC1700A101YM0800X
NJ37PC00658100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health